Successful Use of Remimazolam in a Dialysis Patient With End-Stage Renal Disease and a History of Cardiac Arrest Following Induction of Propofol Anesthesia: A Case Report.

BACKGROUND: Remimazolam, an ultra-short-acting benzodiazepine, has minimal hemodynamic impact compared with propofol, making it a potentially safer alternative for patients at high cardiovascular risk. This report highlights the anesthetic management of a hemodialysis patient with end-stage renal disease who had a prior cardiac arrest induced by propofol-remifentanil anesthesia and subsequently underwent lumbar laminectomy with remimazolam.

CASE PRESENTATION: A 69-year-old male with paroxysmal atrial fibrillation, diabetes mellitus, and dialysis-dependent renal failure required lumbar laminectomy. During the first anesthesia attempt, induction with propofol and remifentanil led to pulseless electrical activity, necessitating resuscitation and surgery cancellation. A second attempt was planned using remimazolam for anesthesia induction and maintenance. With careful perioperative fluid management, remimazolam facilitated stable hemodynamics, and the procedure was completed uneventfully.

CONCLUSION: This report demonstrates that remimazolam effectively stabilizes intraoperative hemodynamics and highlights its potential as a safe and viable anesthetic option for high-risk patients with severe comorbidities, including prior cardiac arrest.